의료보험 재정안정화를 위한 재정조정방안 = Risk Adjustment Mechanism for Reducing Financial Disparity Among Health Insurance Funds

다국어 초록 (Multilingual Abstract)

There is some disparity in the financing ability among health insurance funds. Some funds have accumulated a considerable amount of financial reserves, whereas others are in a weak situation financially. The variations in the affordability of contributions across funds and the differences in the utilization rate have caused financial disparities among funds. Almost all rural insurance funds, whose members have a low income and/or characteristics that lead to high health care costs owing to the large proportion of the elderly, are troubled with budget deficit. Meanwhile, other insurance funds, whose members have above-average incomes and/or low estimated health care costs, such as industrial funds and some urban funds, have budget surpluses. To decrease the financial disparity between insurance funds, it will be necessary to strengthen and incorporate two kinds of financial adjustment mechanisms. The first one is an adjustment of the government`s subsidy to the rural funds according to the level of taxable income and the proportion of elderly persons of each fund. The second one is to strengthen the risk sharing mechanism among overall funds, where the risk sharing funds is used to compensate the medical costs of insurance funds accruing from elderly patients over 65 years old and highly expensive treatments. In order to make the distribution effect efficient, this paper suggests a method measuring the financial ability of each fund, and presents the simulation results, according to the distribution of the overall government subsidy and the rish-sharing funds.